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Adjuvant endocrine therapy is highly effective in women with early stage breast cancer, and decision-making involves integrating prognostic and predictive information which rely on physician judgment that can lead to discordant recommendations. Oncotype DX, a 21-gene recurrence score assay, is widely used as genomic assay and can increase concordance in adjuvant chemotherapy recommendations, as shown by a recent study on NPJ Breast Cancer.
Genomic assays can help identify patients who can be safely spared adjuvant chemotherapy and Oncotype DX provides prognostic information independent of clinicopathologic features, predicting chemotherapy benefit in patients with node-negative and node-positive early breast cancer. In the study, authors selected 30 patients with ER +/HER2− early breast cancer and recurrence score (RS) available from an institutional database; then they asked 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior, but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases. Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7%. Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. «Oncotype DX significantly increased physicians’ confidence in adjuvant chemotherapy recommendations and, besides its recognized and established role in fine- tuning treatment recommendations, reduces the differences in treatment choice among oncologists, who often give discordant recommendations in the absence of a genomic test», authors say. «This aspect is highly valuable, as it guarantees homogeneous treatments to patients across different institutions: such a result is even more valuable in an era in which patients may ask for a second opinion. These results add to a large body of literature that supports the use of genomic assays to determine adjuvant chemotherapy use and encourage a broader implementation of these assays in clinical practice», authors conclude.
Adjuvant endocrine therapy is highly effective in women with early stage breast cancer, and decision-making involves integrating prognostic and predictive information which rely on physician judgment that can lead to discordant recommendations. Oncotype DX, a 21-gene recurrence score assay, is widely used as genomic assay and can increase concordance in adjuvant chemotherapy recommendations, as shown by a recent study on NPJ Breast Cancer.
Genomic assays can help identify patients who can be safely spared adjuvant chemotherapy and Oncotype DX provides prognostic information independent of clinicopathologic features, predicting chemotherapy benefit in patients with node-negative and node-positive early breast cancer. In the study, authors selected 30 patients with ER +/HER2− early breast cancer and recurrence score (RS) available from an institutional database; then they asked 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior, but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases. Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7%. Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. «Oncotype DX significantly increased physicians’ confidence in adjuvant chemotherapy recommendations and, besides its recognized and established role in fine- tuning treatment recommendations, reduces the differences in treatment choice among oncologists, who often give discordant recommendations in the absence of a genomic test», authors say. «This aspect is highly valuable, as it guarantees homogeneous treatments to patients across different institutions: such a result is even more valuable in an era in which patients may ask for a second opinion. These results add to a large body of literature that supports the use of genomic assays to determine adjuvant chemotherapy use and encourage a broader implementation of these assays in clinical practice», authors conclude.
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